Palatal clefting impacts a child's speech, language, and hearing; appearance; occlusion, and psychosocial functioning. Despite years of research attempting to identify the best treatment protocols for children with clefts, there is still much debate about which treatments yield the best outcomes. In an attempt to improve the quality of evidence available for treatments for children with cleft palate with or without cleft lip (CP+L), number of sources have suggested that inter-center studies provide a way to judge the overall outcome of an individual center's treatment protocol. A number of very successful inter-center studies have been conducted in Europe (e.g., EUROCLEFT; SCANCLEFT), resulting in significant changes to treatment protocols. More recently, a group of orthodontists published a series of inter-center comparisons of North American centers: The Americleft Study. The aim of the proposed prospective study is to compare speech outcomes among three different Cleft Palate/Craniofacial Centers in the US in an attempt to identify treatment protocols that are associated with better speech outcomes. One-hundred eighty 5- and 6- year-old children with CP+L (60 per site) and 60 healthy, typically-developing children without CP+L will participate in the study. All children born between 8/1/06 and 6/31/10 who received palatal surgery at one of the three centers will be asked to participate. The children will be evaluated as part of their yearly team visits using a standard protocol developed for this purpose. The video recorded samples will be sent to a central location for editing and posting on a secure website for rating. Blinded ratings will be conducted by trained Speech-Language Pathologists (SLPs) acceptability, hypernasality, and speech production. The raters will be asked to judge whether additional evaluation of velopharyngeal function or speech intervention is needed. Comparisons will be made between the three centers and between each of the three groups of children with CP+L and children without CP+L. This project will also provide benchmarks for success rates that centers can use to judge their outcomes. The findings of this study have the potential to lessen the effects of clefting on quality of life, speech, and psychosocial functioning for childre with cleft palate.